Joints of the Lower Limb Flashcards

1
Q

Osteoarthritis

A

Degeneration of articular cartilage.

Common in the elderly and former athletes.

Loss of cartilage allows bones to directly articulate with each other which produces pain and decreases function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

X-ray findings of osteoarthritis

A

joint space narrowing and osteophytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment of osteoarthritis

A

Stepwise from least invasive to most invasive

rest, activity modification, NSAIDs, physical therapy->steroid or hyaluronic acid injection->surgery (arthrodesis or arthroplasty)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hip Joint- Type

A

Ball and Socket Synovial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hip Joint- Bones involved

A

Acetabulum of Os Coxa and Head of the Femur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acetabulum- composition

A

Composed of the fusion of the ilium, ischium, and pubis to make a cup shaped socket socket for the head of the femur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lunate (articular) surface of acetabulum

A

Deep Surface covered in articular cartilage. as a non-articulating surface in the middle called the acetabular fossa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acetabular Labrum

A

Fibrocartilage extension of the rim of the acetabulum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Transverse acetabular ligament

A

Spans the acetabular notch.

Is continuous with the acetabular labrum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Labrum + Transverse acetabular ligament

A

Increased depth of the acetabulum and increased contact w/ head of femur.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Round Ligament of head of femur

A
  1. Primarily a synovial fold. Also contains a small brach of the obturator artery.
  2. Spans the acetabular notch to the fovea capitis
  3. NOT a significant contributor to blood supply or stability.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hip Capsule

A

The reason the hip is so stable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hip Capsule origins and insertions

A

Bony rim of the acetabulum and the
transverse acetabular ligament to the intertrochanteric line anteriorly and posteriorly it crosses the femoral neck above to the intertrochanteric crest
Does NOT attach to the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bursa for the obturator externus tendon

A

Lack of attachment of the distal/posterior aspect of the hip capsule allows a protrusion of the synovium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Iliofemoral ligament

A

Anterior/ superior part of hip capsule.
Made of 2 bands-
1. Superior: AIIS and superior brim of acetabulum to greater trochanter
2. Inferior: AIIS and Superior brim of acetabulum to Lesser Trochanter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The 3 ligaments of the Hip Capsule

A
  1. Illiofemoral Ligament
  2. Pubofemoral Ligament
  3. Isciofemoral Ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Iliofemoral ligament function

A

Strongest of the hip capsule ligaments
Provides anterior joint support
Helps prevent hyperextension of the thigh
Tightens during hip extension
One reason posterior hip dislocations are more common then anterior.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pubofemoral Ligament

A

Anterior/inferior part of the hip capsule.

Obturator cost of the superior pubic crest and then blends with Iliofemoral Ligament.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ischiofemoral Ligament

A
  1. Posterior part of hip capsule
  2. Ischial acetabular rim to superior femoral neck just medial to base of trochanter.
  3. Is weakest and does not provide great coverage- why posterior hip dislocations are more common then anterior.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Zona Orbicularis

A

Deep fibers of the capsule that wind circularly around the femoral neck

Most noticeable in the posterior aspect of the capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why is there significantly increased ROM during hip flexion as opposed to hip extension?

A

The ligaments of the joint capsule pass in a spiral fashion from the pelvis to the femur and tighten, drawing the head of the femur into the acetabulum, during thigh extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Blood supply to the hip capsule

A

Cruciate Anastamosis
Medical Femoral Circumflex A-
Branch of obturator a via the round ligament of the head of the femur.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Major Blood Supply to head and neck of the femur?

A

medial femoral circumflex a. specifically its retinacular branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Fracture or dislocation of head and neck of femur complications?

A
  • Can cause avascular necrosis if branches of medial circumflex a. is disrupted. Treatment is total hip replacement.
  • sciatic nerve injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Posterior Hip Dislocations

A
  • 90% of all hip dislocations
  • Most often caused by trauma to a flexed hip (because the capsule is loosened during flexion and the femoral head is not tight within the acetabulum)
  • affected leg is shortened, adducted, and internally rotated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Knee Joint

A
  • Modified Hinge Synovial Joint

- Flexion and extension of the leg with minimal amounts of gliding and rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Bony Articulations of the knee (3)

A

-2 femorotibial articulations between the medial and lateral femoral and tibial condyles
-1 femoropatellar
All lined with articular cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Lateral and Medical Menisci

A
  • Sit on top of lateral and medical tibial condyles
  • composed of fibrocartilage and deepen the articulation
  • Help prevent dislocation
  • Act as shock absorber for knee
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Transverse genicular ligament

A

Attaches the anterior horns of both menisci to each other and the tibia to help stabilize the menisci by preventing them from being pulled apart during weight bearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

The femoropatellar articulation

A

Gliding joint between the patella and the femur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Medial and lateral patellar retinacula

A

aponeurotic extensions of the vastus medialis and lateralis that extend from either side of the patella to blend with the rest of the capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Lateral collateral ligament (LCL)

A

AKA fibular collateral ligament
1. strong, cord-like structure extending from the lateral epicondyle of the femur to the lateral surface of the head of the fibula

  1. The tendon of the popliteus muscle travels deep to the LCL separating it from the lateral meniscus
  2. Test integrity with varus stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Medial collateral ligament (MCL)

A

AKA tibial collateral ligament
a. Strong, flat, broad ligament extending from the medial epicondyle of the femur to the superomedial surface of the tibia

b. At its midpoint, the deep fibers of the MCL directly attach to the medial meniscus. This attachment is the reason medial meniscus tears frequently occur in conjunction with MCL tears
c. Test integrity with valgus stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Oblique popliteal ligament

A
  1. A reflection of the semimembranosus tendon over the posterior aspect of the capsule travelling in an inferomedial -> superolateral direction
  2. Blends with the posterior aspect of the capsule to strengthen it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Arcuate popliteal ligament

A

Travels in an inferolateral to superomedial direction from the fibular head->arcs over the popliteus tendon->blends with the oblique popliteal ligament and the rest of the posterior aspect of the capsule to provide added strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

3 intracapsular knee ligaments

A

Anterior cruciate ligament (ACL)
Posterior cruciate ligament (PCL)
Meniscofemoral ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Anterior cruciate ligament (ACL)

A
  1. Extends from the posteromedial aspect of the lateral femoral condyle to the anterior intercondylar region of the tibia
  2. Functions to prevent excess anterior translation of the tibia in relation to the femur or posterior translation of the femur in relation to the tibia depending on which bone is moving
  3. Test integrity with the anterior drawer test or Lachman test
38
Q

Posterior cruciate ligament (PCL)

A
  1. Extends from the anterolateral aspect of the medial femoral condyle to the posterior intercondylar region of the tibia
  2. Functions to prevent excess posterior translation of the tibia in relation to the femur or anterior translation of the femur in relation to the tibia depending on which bone is moving
  3. Test integrity with the posterior drawer test
39
Q

Meniscofemoral ligament

A
  1. Extends from the posterior aspect of the lateral meniscus to the lateral aspect of the medial femoral condyle and may have some fibers that blend with the PCL along the way
  2. Functions to stabilize meniscus and contributes to PCL function
40
Q

Meniscofemoral ligament additional names and anatomy

A
  1. If it travels posterior to the PCL, it is called the posterior meniscofemoral ligament (aka ligament of Wrisberg)
  2. If it travels anterior to the PCL, it is called the anterior meniscofemoral ligament (aka ligament of Humphrey)
41
Q

sprains

A

injuries to ligaments

42
Q

strains

A

injury to tendons

43
Q

Grade 1 Sprain

A

stretching of ligament with minimal disruption of fibers

44
Q

Grade 2 Sprain

A

partial tear of ligament

45
Q

Grade 3 Sprain

A

complete tear of ligament

46
Q

Osgood-Schlatter Disease

A

repetitive contraction of the quadriceps muscles and chronic small avulsions of the tibial tuberosity by the patellar ligament in young athletes who have recently gone through a growth spurt.

47
Q

Proximal tibiofibular joint

A
  1. Gliding synovial joint between the facet on the fibular head and the facet
    on the posterolateral aspect of superior tibia with a small capsule
    surrounding it
  2. Slight gliding movements occur here
48
Q

Proximal tibiofibular joint blood supply

A

The genicular anastomosis

49
Q

Proximal tibiofibular joint innervation

A

Common Fibular Nerve

50
Q

Distal tibiofibular joint big function

A

Essential for stability of the ankle joint because it holds the lateral malleolus firmly against the lateral surface of the talus

51
Q

4 ligaments of the distal tibiofibular joint

A

Interosseous tibiofibular ligament

Anterior and posterior tibiofibular ligaments

52
Q

Interosseous tibiofibular ligament

A

the major connection between the distal tibia and fibula and is a distal thickened continuation of the tibiofibular interosseous membrane

53
Q

Anterior and posterior tibiofibular ligaments

A

sit anterior and posterior to the interosseous ligament to help strengthen the joint

54
Q

Transverse tibiofibular ligament

A

distal continuation of the posterior tibiofibular ligament that spans between the medial and lateral malleoli. This ligament forms the posterior portion of the “mortise” of the ankle joint because it contacts the posterior aspect of the talus

55
Q

Transverse tibiofibular ligament

A
  1. Distal continuation of the posterior tibiofibular ligament that spans between the medial and lateral malleoli.
  2. This ligament forms the posterior portion of the “mortise” of the ankle joint because it contacts the posterior aspect of the talus
56
Q

High ankle sprain

A
  1. Does not directly involve the ankle joint.
  2. It is a sprain of the distal tibiofibular syndesmosis usually occurring as a result of contact sports (e.g. football) or sports requiring utilization of a rigid boot (e.g. skiing/snowboarding, hockey).
57
Q

Ankle joint

A

AKA talocrural joint
Hinge-type synovial joint between the distal ends of the tibia and fibula and
the superior aspect of the talus

58
Q

malleolar mortise

A
  1. . Distal aspects of the tibia and fibula along with the transverse tibiofibular ligament
  2. Where the trochlea of the talus sits
  3. Strengthened by strong collateral ligaments and a joint capsule that is lined internally by synovial membrane
59
Q

The 3 Lateral ligaments of the ankle

A

Anterior talofibular ligament
Calcaneofibular ligament
Posterior talofibular ligament

These help to resist against excessive inversion of the ankle but are fragile and are easily sprained.

60
Q

Anterior talofibular ligament

A

flat, weak ligament that extends from the
anteromedial aspect of the lateral malleolus to the neck of the talus
ATF- always tears first.

61
Q

Posterior talofibular ligament

A

thick, strong ligament that extends medially and slightly posteriorly from the distal posteromedial aspect of the fibula to the lateral tubercle of the talus

62
Q

Calcaneofibular ligament

A

Rounded ligament that extends from the inferior tip of the lateral malleolus to the lateral surface of the calcaneus

63
Q

Medial ligament of the ankle

A

AKA the deltoid ligament
Actually 4 separate ligaments
Help to prevent excessive eversion of the ankle

64
Q

The 4 ligaments that make up the Medial / deltoid ligament of the ankle

A

anterior to posterior

  1. anterior tibiotalar ligament,
  2. tibionavicular ligament,
  3. tibiocalcaneal ligament,
  4. posterior tibiotalar ligament
65
Q

Ankle sprain

A

Most frequently injured major joint in the body.

Almost always results from an inversion injury of a weight-bearing, plantar flexed foot.

66
Q

Ligaments injured in an ankle sprain

A

The anterior talofibular ligament is the most commonly sprained structure followed by the calcaneofibular ligament.

67
Q

Why does an ankle sprain happen to a plantar flexed foot most commonly?

A

The shape of the trochlea of the talus and how tight the ligaments of the ankle are stretched.

  1. The trochlea is narrower posteriorly causing less surface area articulation with the tibia when the foot is plantar flexed
  2. the ligaments of the ankle are more relaxed during plantar flexion leads to less stability
68
Q

Ankle fractures

A

Caused by excessive eversion or inversion of the ankle

69
Q

bimalleolar fracture

A

An avulsion fx of the medial malleolus and a fx of the distal fibula.
Caused by excessive eversion when the deltoid ligament pulls on the medial malleolus. After the medial malleolus avulses, if the eversion force is strong enough, the talus will slide laterally on the tibia causing stress on the distal fibula causing another break

70
Q

“trimalleolar” fracture

A

An avulsion fx of the medial malleolus and a fx of the distal fibula AND THE distal tibia. Caused by the tibia shifting forward on the talus, after a bimalleolar fx.

71
Q

Subtalar joint

A
  1. Synovial joint between the talus and calcaneus

2. inversion and eversion of the posterior foot

72
Q

Talocalcaneonavicular joint

A

Complex synovial joint between the distal aspects of the talus and calcaneus and the proximal portion of the navicular

73
Q

Ligaments of the subtalar joint

A

medial, lateral, posterior, and interosseous talocalcaneal ligaments

74
Q

The Spring Ligament

A
  1. The plantar calcaneonavicular ligament.
  2. Extends between the sustentaculum tali of the calcaneus and the posteroinferior surface of the navicular
  3. Supports the talocalcaneonavicular joint
  4. Important with weight transfer from talus during weight-bearing, and helps maintain the longitudinal arch
75
Q

Transverse tarsal joint

A

Composed of 2 separate joints (talonavicular and calcaneocuboid) that are aligned transversely to allow for increased inversion and eversion of the foot

76
Q

tarsometatarsal joints, and intermetatarsal joints

A

Relatively small and tightly joined by ligaments so slight movement
occurs between them

77
Q

Metatarsophalangeal and interphalangeal joints

A

Individual synovial joints that mainly allow flexion and extension

78
Q

Long plantar ligament

A
  1. Extends between the plantar surface of the calcaneus to the cuboid and base of the metatarsals
  2. Helps maintain longitudinal arch
  3. There is a gap in this ligament between its attachment to the cuboid and metatarsals that acts as a tunnel for the fibularis longus tendon as it traverses across the plantar aspect of the foot
79
Q

Short plantar ligament

A
  1. aka plantar calcaneocuboid
  2. Extends between the anterior plantar surface of the calcaneus to the plantar surface of the cuboid
  3. Helps maintain the longitudinal arch
80
Q

Medial longitudinal arch- Bones involved

A
calcaneus, 
talus, 
navicular,
3 cuneiforms, 
3 most medial metatarsals
81
Q

Medial longitudinal arch

A
  1. Higher than the lateral longitudinal arch with the talar head being the keystone.
  2. The talar head is supported by the spring ligament (calcaneonavicular ligament)
82
Q

Medial longitudinal arch- muscles involved

A
  1. tibialis anterior,
  2. tibialis posterior
  3. fibularis longus,
  4. plantar aponeurosis,
  5. intrinsic plantar muscles
83
Q

Lateral longitudinal arch- Bones involved

A

calcaneus,
cuboid,
2 lateral metatarsals

84
Q

Lateral longitudinal arch

A

Flatter than its medial counterpart and rests on the ground during standing

85
Q

Lateral longitudinal arch- ligaments

A

long and short plantar ligaments

86
Q

Transverse arch - bones involved

A

cuboid,
cuneiforms,
bases of the metatarsals

87
Q

Transverse arch - Ligament support:

A

long/short plantar and spring ligaments

88
Q

Transverse arch - Muscle support

A

tibialis posterior and fibularis longus

89
Q

Passive stabilization of the boney arches

A

four layers of fibrous tissue (plantar aponeurosis, long plantar ligament, short plantar ligament, and spring ligament)

90
Q

Dynamic stabilization of the boney arches

A

from intrinsic and extrinsic muscles of the foot

91
Q

Gout

A

monosodium urate crystal deposition in joints causing acute inflammation with a possibility of recurrent attacks causing chronic deformities

92
Q

Podagra

A

Gout of the 1st metatarsal-phalageal joint